Dabbing has been gaining popularity among young people in recent years due to its ability to deliver a high concentration of tetrahydrocannabinol. When produced illegally, it is usually contaminated by toxic substances and associated with multiple health hazards. We present the case of a 66-year-old woman who developed hypersensitivity pneumonitis after dabbing butane hash oil for the first time and was successfully treated with corticosteroids with complete resolution of her symptoms. This case report emphasizes the respiratory complications associated with using a noxious substance like butane hash oil and gives physicians an insight into the diagnosis and management of dabbing-induced hypersensitivity pneumonitis.

No abstract

Nicotine replacement therapy (NRT) and varenicline are both effective in helping smokers quit. There is growing interest in combining the two treatments to improve treatment outcomes. None of the available first-line pharmacological therapies to treat tobacco dependence have been labeled for use in combination with other therapies. Seven firstlinepharmacotherapies that are currently available are recommended in clinical practice guidelines to treat tobacco dependence; all of these therapies have been tested to be effective for increasing tobacco abstinence rates when used as monotherapies in comparison with a placebo. We conducted a systematic review and meta-analysis to determine if combined NRT provides any significant benefit over nicotine patches alone for smoking cessation. METHODS:We conducted a systematic search of the PubMed database from inception through APRIL-2021 for studies comparing combined nicotine replacement therapy and varenicline versus varenicline alone using the terms "Varenicline", "Varenicline þ nicotine replacement". Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The random-effects model was used for all variables, and publication bias was assessed using Egger's test.RESULTS: Three randomized controlled trials published between 2006 and 2021, examining a total of 904 patients, were included in our analysis. We found combination NRT and varenicline to be superior to varenicline alone regarding abstinence at three and six months with relative ratios of 1.195 (95% CI 1.048 to 1.363) (I 2 =54.641%) and 1.376 (95% CI 1.14 to 1.66) (I 2 =29.568%) respectively. We also found no significant difference in adverse effects namely, nausea, abnormal dreams and insomnia with relative ratios of 0.875 (95% CI 1.048 to 1.363) (I 2 =0.000%), 0.926 (95% CI 0.600 to 1.430) (I 2 =67.248%) and 1.185 (95% CI 0.779 to 1.801) (I 2 =0.000%) respectively. CONCLUSIONS: Our results suggest that combination NRT and varenicline is superior to varenicline alone regarding abstinence at three months and six months follow-up visits, with no difference in adverse effects of nausea, abnormal dreams, and insomnia between both groups in the same time frame.CLINICAL IMPLICATIONS: A combination of NRT and varenicline is more effective than using varenicline alone as first-line therapy for smoking cessation.

Figure 1. Neo-ileum biopsy: The atypical cells are large with ovoid to irregular nuclear membrane, hyperchromatic nuclei, variable prominent nucleoli, and cytoplasmic clearing.

No abstract